​​Section 28: Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Claim Denials, CR 129350​

MaineCare has identified some Section 28 claim lines submitted with service code H2021 that denied for Benefit Restriction Group Validation Failed due to a system error. This error has been corrected. We will reprocess the affected claims. No action is required by providers.  

The Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) are as follows.  

  • CARC 96: Non-covered charge(s).  

  • RARC N130: Consult plan benefit documents/guidelines for information about restrictions for this service.  

Nursing Facilities (NF): January Claims Hold and Navigating Rate Reform Billing Changes

Request to Hold January 2025 Claims

The Department is working to implement billing changes reflecting NF rate reform presented at the October 23, 2024 public forum and we expect these changes to be operational by February 1, 2025.

Please hold claims for services delivered in January 2025 until these changes are implemented and announced in a future notice. 

Subscribe to